3. Eat, Drink, Have Sex, Use Drugs

4. Rate of Change  Brain Development Source: Tapert & Schweinsburg, 2005

6. “Act first, think later” More risky, impulsive behaviors Less than optimal planning or consideration of negative consequences Preference for physical activity and sensation seeking Implications of Incomplete Brain Development

17. Addiction is a Developmental Pediatric Disease Source: NIAAA National Epidemiologic Survey on Alcohol and Related Conditions, 2003

18. Health Literacy is not tested  We know that health education/health education teachers have been reduced over the past 10 years. (DESE Health Frameworks are from 1999)  Some High Schools have 1 Health Class for 1 semester in High School.  DESE acknowledges that children/adolescents need skills-based health education at all levels to make good decisions that transfer to many situations.

19. The value of Health Education at all levels

21. Prevalence of Lifetime Alcohol Dependence by Age of First Alcohol Use and Family History of Alcoholism Parental History Positive Total Parental History Negative

27. 30 Day Prevalence of Daily Use of Cigarettes, by Grade, 1975-2013

28. FIGURE 1. Estimated percentage of high school students who used tobacco in the preceding 30 days, by tobacco product — National Youth Tobacco Survey, United States, 2011–2014

30. Risk Factors Alcohol or Drug Use PEERS Friends use Norms favor use Early initiation Gang involvement Rebelliousness

31. Risk Factors Alcohol or Drug Use SCHOOL Lack of commitment to school Norms favor use Academic failure Alienation

32. Risk Factors Alcohol or Drug Use PARENTS Availability Norm favors use Attitudes

33. Think you drink a lot? This chart will tell you…

34. Risk Factors Alcohol or Drug Use COMMUNITY Availability Norms favor use Attitudes Community disorganization Violence

35. Emotional neglect Abuse Adverse childhood experiences Household dysfunction Adverse Childhood Experiences Emotional Neglect Abuse Household Dysfunction

38. Three Types of ACEs

39. Adverse Childhood Experiences - ACE

40. Talk Early, Talk Often “Delay, Delay, Delay or Avoid Altogether” Handouts on your Thumbdrive Script for Calling Parents when a child/adolescent in on Narcotic after surgery. NY Times article on Telling kids the truth From Prescription to Heroin (poster from DPH) What Should Parents know about the Opioid Crisis Substance Abuse Prevention Tips for Parents Safeguard your Meds BSAS MA Youth Treatment Services Family Dinners make a Difference Find your ACE score This slide show

51. http://www.nytimes.com/2011/09/01/us/01drugs.html?src=me&ref=us 51

61. Opioids and Misunderstandings Family members (and patients) often misunderstand the differences Need to re-educate Physical Dependence Tolerance Physiologic adaptations to chronic opioid therapy Addiction Maladaptive behavior associated with opioid misuse Savage SR, et al. J Pain Symptom Manage. 2003 Jul;26(1):655-67.

62. Drug Seeking Clinical syndrome presenting as… Loss of C ontrol C ontinued use despite harm C raving Aberrant Medication Taking Behaviors (pattern and severity) Savage SR, et al. J Pain Symptom Manage. 2003;26:655-667. Addiction is NOT the same as physical dependence Addiction C ompulsive use

63. Small or “pinpoint” pupils An overall unhealthy look Weight loss Vomiting Constipation “Nodding off” to sleep Laxative use In females, not getting a period Depression Track marks on arms (scars or bruises from using needles) Itches and scratches on the skin Loss of friendships Problems in school or at work Lose interest in activities Signs and Symptoms at School

64. More time spent away from home Frequent, secret phone calls Trouble with the police Missing money, credit cards, and/or valuables Pawn slips Purchases returned for refunds Small plastic Ziploc bags Bottles of vinegar and bleach and cotton balls Aluminum foil or chewing gum wrappers with burn marks Spoons with burn marks or missing spoons Signs at Home

65. Signs and Symptoms of Withdrawal Diarrhea Sweating Dilated (very big) pupils Irritability (moodiness) Anxiety (feeling worried or nervous) Trouble sleeping Talking about craving medicines or drugs Complaining about pain — especially stomach cramps, muscle aches, and bone pain

66. https://www.youtube.com/watch?v=Uq6AxrEY3Vk